Provider Demographics
NPI:1457353484
Name:GROSS, MEL KEITH (AUD)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:KEITH
Last Name:GROSS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1251 NILLES RD
Mailing Address - Street 2:STE 7
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7206
Mailing Address - Country:US
Mailing Address - Phone:513-829-7111
Mailing Address - Fax:513-829-7114
Practice Address - Street 1:1251 NILLES RD
Practice Address - Street 2:STE 7
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7206
Practice Address - Country:US
Practice Address - Phone:513-829-7111
Practice Address - Fax:513-829-7114
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0180231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGRO522993Medicare ID - Type Unspecified